COVID-19: Type 2 Diabetes

Lord McColl of Dulwich Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

The Government and the Department of Health and Social Care are reviewing the many impacts of Covid-19 that noble Lords will acknowledge. We are still trying to understand the various implications of lockdown. We have seen increases in weight leading to more type 2 diabetes. I will write to the noble Lord giving a detailed answer to his question.

[Lord McColl of Dulwich (Con)]

My Lords, as my noble friend Lady Jenkin has already mentioned, we have known for many years that reducing weight can reverse type 2 diabetes. With others, I was doing this successfully over 60 years ago. This draws attention to the urgent need for an even greater campaign to deal with the 71% of people in the UK over the age of 30 who are obese or overweight.

[Lord Kamall (Con)]

The Government have implemented weight-management services. Tier 2 behavioural weight-management services have been provided by 98% of local authorities thanks to the distribution of £30.5 million as part of the adult weight-management services grant. Additionally, £12.8 million was invested in an NHS digital weight-management programme for individuals with multiple long-term conditions, as well as NHS staff. There are a number of other programmes related to weight management which I may well go into in answering a later question.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord McColl of Dulwich Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord McColl of Dulwich (Con)]

My Lords, I have been given permission to sit while giving my speech because I am having great difficulty with my vision. First, I thank the noble Lord, Lord Patel, for initiating this discussion on the report on ageing. The report makes the apt point that, although life expectancy is increasing,

“the UK has seen low rates of life expectancy increases compared with most European and other high-income countries.”

With any medical condition, we must focus first on diagnosis, secondly on aetiology and, thirdly, on treatment. Well, the diagnosis is clear: the people of the UK are the most unhealthy in Europe. Seventy one per cent of those aged over 30 are obese or overweight. When I first mentioned that statistic last year in the Chamber, it was dismissed by a prominent politician as being over the top. I was not over the top; I was just dealing with facts, truth and science.

As the noble Baroness, Lady Sheehan, mentioned, obesity leads to widespread disease, including type 2 diabetes, hypertension, strokes, heart attacks, dementia and many other conditions that cause premature ageing, morbidity and death. The fat in the gross excess of fat cells leaks out, impairs the immune system and leaves the polluted body susceptible to very many diseases, especially infections such as Covid-19. The countries with the highest prevalence of obesity are the ones with the greatest incidence of Covid-19. So when the Prime Minister was accused of being responsible for 130,000 deaths, it was a false accusation. The aetiology of obesity epidemics is simply that people are putting too many calories into their mouths. Therefore, the treatment is, first and foremost, to get obese people to put fewer calories into their mouths. In fact, the Prime Minister was the first national leader to advocate eating less in order to reduce the obesity epidemic. He showed the way by losing three stone himself and coined the phrase, “Don’t be fatty at 50”.

Before we focus on complex solutions, we must first ensure that we have mastered the simple ones. It is not the case that eating less is impossible; what is impossible is to go on eating too much and remain healthy. There is no doubt that eating less requires effort and, for some, it is very difficult indeed, but the effort pays off in terms of morbidity, mortality and improving the quality of life in old age.

It was said that one group of people suffered more from Covid because of poverty and government cuts. Then an honest commentator pointed out that this particular group of people is more likely to suffer from heart attacks, strokes, type 2 diabetes and hypertension, but no one had the courage to say that the cause of those four conditions was mainly obesity. The critics say that they were obese because they could not afford the right food, but they would not be obese if they ate less of the wrong food.

Elements of the scientific world and some authorities have confused the public by mixed and inaccurate messages—for instance, that physical exercise is the answer to the obesity epidemic. The scientific institution known as NICE has maintained for years that all the calories we eat are used up on exercise, but surely one of the 500 employees of NICE could have gone to the gym, exercised for half an hour on a machine and seen how few calories they expended. On average, approximate intake of adults is 2,000 to 2,500 calories a day, which means that a person would have to exercise for four or five hours every day to burn up the calories they ate. This would increase their appetite and their calorie intake. I should emphasise that physical activity is essential for good health but is not an effective way of reducing weight.

There should be a clear message to the public that obesity is a disease that destroys the human body slowly and, as people get older, produces an enormous amount of suffering and death. The Department of Health has not always been helpful, in that it advocated a low-fat diet—but it is fat that acts as a brake, limiting the amount we eat. We clearly need to limit the amount of saturated fat, but unsaturated fat is fine. As fat leaves the stomach it goes into the duodenum and releases hormones that act on the stomach, delaying its emptying, thus giving an early sensation of fullness and satiety. After the fat has been emulsified and absorbed, it moves down the small intestine and normal service is resumed by the stomach. This is a beautiful mechanism that limits the amount we eat but, not surprisingly, the food industry dislikes it.

In the 1970s, Professor John Yudkin of London University set out clearly in his research that fat was not the problem; the problem lay in sugar. The food industry not only deliberately demonised fat but demonised Professor Yudkin. It was influential in his dismissal from his university post. The food industry advocated a low-fat diet, which is not only tasteless but bad for sales. It therefore added large quantities of sugar to the diet, and so the rot set in, with increasing obesity leading to the obesity epidemic.

Whole milk used to play an important part in limiting how many calories people ate. Skimmed milk was an industrial by-product which was at first discarded, then fed to animals and later to humans. The Department of Health has not helped matters by continuing to advocate a low-fat diet. It told GPs not to call patients obese because it was judgmental; it does not seem to realise there is a distinct difference between being judgmental and making accurate diagnoses.

The committee’s report focuses on the cure for the lifestyle choices of an ageing population, but prevention is better than cure. We could save millions from untimely deaths and billions in expenses if we focused on prevention. The struggle to keep an ageing population healthy has no greater challenge than this: the problems posed by bad choices. What is the Government’s role? It is not to tell people what to do. Instead, it is to honestly present them with the facts and the truth, and encourage them to make the right choices to grow older unhindered by increasing morbidity and mortality.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Lord McColl of Dulwich Excerpts

Thursday 22nd July 2021 Lords Chamber

[Lord McColl of Dulwich (Con) [V]]

My Lords, my noble friend Lady Jenkin has already mentioned that for many years in this House we have been calling for action to deal with the obesity epidemic, mainly with the slogan, “The obesity epidemic is killing millions, costing billions and the cure is to put fewer calories into their mouths”. This will save a great deal of money and reduce the strain on the NHS, as has already been mentioned.

It will probably come as no surprise to noble Lords that I support these draft calorie labelling regulations. There are a few problems, which I think can be ironed out quite easily. First, fat, preferably unsaturated fat, acts as an important brake on how much we eat, as does whole milk. This was demonstrated by scientists in Canada and, recently, Danish scientists showed that whole milk actually reduced the level of cholesterol in the blood. We need to remind ourselves that fat produces twice as many calories as protein and carbohydrate, so this needs to be taken into account in calorie labelling and working out what to buy and eat.

These regulations, as has been mentioned, can present problems for those with eating disorders. I hope that it will help them to have menus available that have no mention of calories at all, and I hope that it will be essential for restaurants to have those menus available.

On average, 2,000 calories per day is mentioned, but of course the total number of calories one should eat will vary substantially from person to person, according to occupation, age and weight. It is worth reminding ourselves that the all-powerful food lobby was the culprit in causing this obesity epidemic in the first place. It wanted to get people to eat more food but realised that it was the fat they were eating that slowed the stomach emptying and made them feel full and satisfied early on in the meal. So the lobby demonised fat and insisted on a low-fat diet, which is so tasteless that it then had to add a great deal of sugar to make its manipulated food palatable. It pilloried those who opposed it, including Professor John Yudkin, who was sacked from his university chair of nutrition in London for warning against the high-sugar, low-fat diet. So much for the so-called independence of universities. We need to counter the anti-people’s lobby, which wants to stop people from having whole milk and healthy fat because these villains know that fat reduces appetite and reduces their ill-gotten gains.

It was gratifying to see reference at the end of the document warning against the potentially fatal combination of Covid and obesity. People should take note of that, especially in both Houses of Parliament—that obesity is one of the problems causing high mortality from Covid. I wish more people would join the Prime Minister’s campaign to tackle the obesity epidemic with his slogan, “Don’t be a fatty in your fifties”.

Covid-19: Aligning UK and Foreign Entry and Return Requirements

Lord McColl of Dulwich Excerpts

Monday 19th July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

[Inaudible]—are engaging with a range of international partners, including the EU and the US, on mutual recognition. Ministers have agreed to begin the formal process of reaching a technical agreement with the EU on mutual recognition of vaccine certificates. This would allow the digital verification of vaccine certificates between the UK and the EU. We believe that this process could be complete within a month, pending the Commission’s acceptance of our application.

[Lord McColl of Dulwich (Con) [V]]

My Lords, have the discussions with these countries involved the question of herd immunity, bearing in mind that countries with low levels of vaccination which have closed their borders will have fewer Covid infections? That could result in less herd immunity in the long term in countries such as New Zealand and Australia, which have closed their borders.

Organ Tourism and Cadavers on Display Bill [HL]

Lord McColl of Dulwich Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Lord McColl of Dulwich (Con) [V]]

My Lords, I also thank the noble Lord, Lord Hunt, for presenting this valuable Bill. Of all the different operations that I used to do, kidney transplantation was the most exciting. When the vein and artery were connected to the donor kidney, it would spring to life. As a contribution to good Anglo-French relations, I pay tribute to France: the French kidneys were the best of all because they would start functioning immediately by peeing on the operating table. The reason for this was said to be French wine being a good diuretic. As there was always a shortage of kidneys, there was a European system for sharing in order to have the best match for each patient. Unfortunately, this shortage led to abuses of all kinds. On many occasions, live donors were paid to give their kidneys, for a relative or a stranger. It later transpired that genuine consent was often not obtained.

Later, the horror of the Chinese practice of forcibly taking kidneys from prisoners came to light. The numbers involved have shocked the world, but is the world going to repeat its failure to take action against the Nazi atrocities, which also included horrific medical experiments on prisoners? Instead of an effective response to China, the West continues to allow it to buy up our industries, enabling the Chinese Government’s plan to dominate and control the world. When will the world wake up and take effective action?

On medical devices, it is worth saying that the medical profession has a history of reluctance to put foreign materials into bodies. The surgeon who pioneered the use of metal plates and screws to fix fractures was threatened with removal from the medical register. Another example was an eye surgeon, Harold Ridley, who was carrying out a standard operation for cataracts in 1949, simply removing the cataract and sewing up the eye. A medical student who was watching the operation suggested that perhaps the cataract should be replaced with an artificial lens. What the surgeon said at the time was not recorded, but he kept the suggestion in his mind and, the following week, he noticed a piece of plastic from a smashed windscreen in a pilot’s eye—but there had been no reaction to it. So began artificial lens implantation. In spite of great opposition, it was finally accepted 25 years later. New inventions are often opposed. Careful evaluation is essential to allow and promote good new developments as well as to stop harmful ones.

Folic Acid

Lord McColl of Dulwich Excerpts

Tuesday 13th July 2021 Lords Chamber

[Lord McColl of Dulwich (Con) [V]]

My Lords, one of the first to indicate that folic acid could prevent spina bifida was Professor Richard Smithells in 1980. That was accepted 11 years later, which is nothing compared with the present delay. Spina bifida is one of the commonest congenital defects and is easily prevented by adding folic acid to flour, which is what the Americans did 23 years ago, thus preventing 1,300 babies having that tragic condition every year. We keep hearing about consultations and meetings, which some of us regard more as group psychotherapy than as achieving anything. When will action be taken?

[Lord Bethell (Con)]

My Lords, I completely understand and appreciate the sense of frustration and urgency that my noble friend expressed, but I emphasise that this is a massive national measure. It has to be conducted in a way that takes the nations with us, that people feel confident that the right processes have been adhered to and that there is no doubt about the safety of the measure. This is not a question of foot dragging, quite the opposite. We are doing this in a thorough way that reflects the practicalities and realities of the machinery of the United Kingdom Government.

Medical Devices (Northern Ireland Protocol) Regulations 2021

Lord McColl of Dulwich Excerpts

Monday 12th July 2021 Grand Committee

[Lord McColl of Dulwich (Con) [V]]

My Lords, as there are more than half a million of these devices on the market, it is understandable that effective regulation should be in place and workable. It is also clear that most of us will need one of these devices at some time in our life. It is to be hoped that these regulations will give patients more information and choice, and that they will benefit from more up-to-date therapies. I ask the Minister this: what will be the effective way of seeking expert opinions on the wisdom of a proposed new operation that does not necessarily involve a medical device? It would be helpful to have a second opinion on whether it is likely to be feasible and safe.

As there are often notoriously long delays in obtaining answers from official bodies, and we are talking about regulations now, has any thought been given to placing a regulation to require answers within a certain time?

There has been discussion about a robust financial compensation mechanism to ensure that patients are dealt with fairly and justly for the damage caused by defective devices and by their inappropriate use in certain parts of the body. For instance, the mesh which caused so much damage in operations for incontinence is used widely and safely in hernia operations. Could the Minister tell the Committee who will operate these compensation mechanisms? Who will decide whether compensation is justified and how much to award?

Women’s Health Outcomes

Lord McColl of Dulwich Excerpts

Thursday 8th July 2021 Lords Chamber

[Lord McColl of Dulwich (Con) [V]]

My Lords, I join others in thanking the noble Baroness, Lady Jenkin, for initiating this debate. In my practice of medicine and research, mental health has always been one of my concerns, and it is obviously a very important feature in the health of women. One survey, which I think has already been mentioned, showed that 90% of people believe that mental health affects physical health and 90% believe that physical health affects mental health.

In trying to achieve better outcomes, I think it is sensible to look for cost-effective ways. For instance, the mental harm done by loneliness can be mitigated by frequent visits from friends and relatives, and this may also delay the onset of Alzheimer’s disease and help them when the condition progresses. Importantly, there are many ways to reduce stress—for instance, bringing in a four-day week. When a three-day week was introduced in 1974, there was no drop in productivity, which was interesting and surprising.

Better outcomes could be achieved by reducing violence, rape and abuse of all kinds, and alerting the public to the increased domestic violence following football matches, as the noble Baroness, Lady Jenkin, mentioned. Violence against women is also bound up with pornography and prostitution. A Swedish law making it illegal to pay for a prostitute reduces the opportunities for violence against women and could be passed here in this country. Those opposing such a law might be asked whether they have an interest to declare.

It is estimated that there are several million disabled people being cared for by women at home. For them, respite care is absolutely essential.

Lastly, a great deal of mental and physical ill health is due to the obesity epidemic, which has caused an enormous amount of ill health and is also responsible, in this country and many others, for the high mortality from Covid. There is only one way of dealing with obesity: put fewer calories into the mouth. The noble Baroness, Lady Jenkin, has done a great deal, in practical ways, to achieve this by advocating ways of finding and cooking healthy and affordable food and inviting people to these healthy and cheap lunches.

We must make a real effort to achieve better health outcomes for women in this country.

Health: Dementia

Lord McColl of Dulwich Excerpts

Monday 5th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I pay tribute to the role of carers in the kinds of situations the noble Baroness describes. We are doing an enormous amount to supply training for carers in all facets of their delivery, including support in caring for those with dementia. I am not sure that I can make the guarantee that she seeks right now, but I reassure her that this is one area of our investment in carers that we take extremely seriously.

[Lord McColl of Dulwich (Con) [V]]

My Lords, while these patients are waiting for appointments, could some way be found to encourage relatives and close friends to help those with early dementia by having frequent conversations with them and helping them learn by heart poems they used to be able to recite in earlier years? That might also prove helpful to those relatives and friends, because loss of memory tends to affect us all as we grow older.

[Lord Bethell (Con)]

My noble friend makes a very touching and constructive point, because social engagement and involvement in the community keep older people sharp and their brains engaged and help stave off the ravages of age and the diminution of mental faculties. We all have a role to play in supporting the elderly and those with mental challenges. My noble friend is entirely right to call on the entire community to step up to that role.

Hospital Waiting Lists

Lord McColl of Dulwich Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

I completely take on board the noble Baroness’s advice. When it comes to recruitment, it is right that local engagement with local education has to be the way forward. I can report that the recruitment efforts and marketing campaign that we have put in place to recruit 50,000 new nurses, more GPs and more staff across the healthcare system are working extremely well. There is a renewed interest in careers in health—that is one good dividend of this awful pandemic.

[Lord McColl of Dulwich (Con) [V]]

My Lords, the Government’s £1 billion elective recovery fund is most welcome. Will the Minister support this sum being made available every year until we see light at the end of the tunnel? Can he encourage health authorities to redouble their efforts to get the 40 million people in the UK who are overweight to return to a normal weight and thereby begin to release resources to treat more urgent cases, such as cancer patients?

[Lord Bethell (Con)]

On the elective recovery fund, I cannot make that commitment at the Dispatch Box but I reassure my noble friend that we are in it for the long haul and we recognise that this will be a major project needing major resources. When it comes to the health of the nation, the obesity strategy is a cross-departmental and energetic programme that tackles the issues that my noble friend is concerned about. He is entirely right that the costs of our healthcare system are predetermined by the overall health of the nation, and that is why we encourage people to eat well and lead healthy lives.